Association of immunologic and virologic factors with myocardial infarction rates in a US healthcare system.

BACKGROUND The effects of immunologic and virologic factors on acute myocardial infarction (AMI) rates in patients with HIV are unclear. METHODS HIV-infected patients in a US healthcare system were assessed for AMI. RESULTS Of 6517 patients with HIV, 273 (4.2%) had an AMI. In a model adjusting for cardiovascular risk factors, antiretroviral medications, and HIV parameters, CD4 count less than 200/mm (odds ratio, 1.74; 95% confidence interval, 1.07 to 2.81; P = 0.02) predicted AMI. Increased HIV viral load was associated with AMI accounting for cardiovascular disease risk factors and antiretroviral medications but was not significant when CD4 count was considered. CONCLUSIONS Immunologic control appears to be the most important HIV-related factor associated with AMI.